Organization
WK PIERRE AVE COMMUNITY HEALTH EDUCATION AND WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J GAVIN (NETWORK ADMINISTRATOR)
(318) 212-8624
Entity
Organization
Contact information
Practice address
1327 PIERRE AVE, SHREVEPORT, LA 71103-3056
(318) 212-8624
(318) 226-8545
Mailing address
1327 PIERRE AVE, SHREVEPORT, LA 71103-3056
(318) 212-8624
(318) 226-8545
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447188
—
LA
Enumeration date
07/06/2006
Last updated
05/14/2014
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